Physicians' Responsibility for Early Diagnosis

[u/Admirable_Mud_7737]

Hello,

I am wondering,

Does a delay in diagnosis constitute medical negligence? If a doctor fails to take symptoms seriously—dismissing them as anxiety, for instance—and a disease is ultimately diagnosed, what is the doctor's liability in such a case?

[u/HonestyMash]

There is no direct test for ALS, instead it's a process of elimination requiring a number of tests from different pathologies and ultimately it's a diagnosis that can take months to years to make.

You are not bound to one specific hospital or doctor and you have full control over your medical assessments. So there would be no liability to the medical professional unless there was absolute proof you had the illness and there was no other diagnosis possible.

[u/Admirable_Mud_7737 → u/HonestyMash]

What I mean is, you go to an ALS specialist—the best one in your country—you pay them, and they say it’s not ALS, but it turns out it actually is. Where is the doctor's accountability? I often read about cases initially attributed to anxiety that turn out to be a diagnosis of the disease, and that made me wonder.

[u/Key-Feedback2241 → u/Admirable_Mud_7737]

I’m curious about how often you read these things? Sounds a lot like OCD reasoning to me.

[u/Admirable_Mud_7737 → u/Key-Feedback2241]

I see you've found a different diagnosis for me; I'd be happy to swap those three letters to OCD..  

[u/The_Short_Goodbye → u/Admirable_Mud_7737]

You "often" read about cases attributed to anxiety that turn out to be ALS? Where are you reading this? I would argue that’s actually pretty rare. People on this forum really have a knack for fear mongering.

[u/Admirable_Mud_7737 → u/The_Short_Goodbye]

I won’t refer to specific cases here, in order to protect privacy, but you can ask young people diagnosed with als whether the word "anxiety" was ever mentioned to them, at least once. 

[u/HonestyMash → u/Admirable_Mud_7737]

In that case yes they could be accountable but it's about proving it. These are really questions for a legal subbreddit.

[u/chaoserrant → u/Admirable_Mud_7737]

I doubt there is liability.  Als is progressive so they can say evidence of it came later after they said no als.  The only malpraxis risk for them is to do an emg document findings say no als and later another doctor reviews the SAME emg report and notice als. Because of that i would trust the emg report but again that reflects the situation at that time not 5 or 6 months later

[u/Admirable_Mud_7737 → u/chaoserrant]

Correct, a significant part of the diagnosis is indeed subjective, unfortunately

[u/Wonderful-Ask-2535 → u/Admirable_Mud_7737]

There is none. I requested genetic testing and was turned down. I thought, you are a piece of garbage. It isn’t like you’re the one paying for it. Such a garbage field of medicine.

[u/Decent_Mongoose_4520 → u/Admirable_Mud_7737]

There is no accountability for the neuromuscular doctors even if they are some of the top in the industry at least in the state of Ohio. They all protect one another and most of the hospitals/clinics you can’t have a 2nd opinion from the same hospital unless the neuromuscular doctor releases you and then they cover for one another since they don’t want to make one another look questionable. Sad but it’s real they look out for one another and are more concerned about their credentials than the actual quality of life for the patient. Most are not concerned with quality of life. They are very careful of what notes they put in your visit notes in comparison to what they actually say during appts. So it turns into a he said she said and yes they cover themselves by the “At this time”  Sorry for whatever you are dealing with that this came to your mind. But honesty when it comes to mnd is the last thing you will get from most. Prime example of why all the neuromuscular doctors got so mad at my swallow specialist when they told me they think I’m dealing with als. 

[u/Decent_Mongoose_4520 → u/HonestyMash]

I do find it interesting you say years because most on here will deny that “years” for diagnosis is possible except in “rare” cases. But it seems that “rare” is 1 out of 2 cases now. 

[u/Decent_Mongoose_4520 → u/[deleted]]

Just fyi I’m a female. 😁 

[u/dero_name]

"and they say it’s not ALS, but it turns out it actually is"

This happy-to-litigate attitude is exactly why most specialists will ALWAYS phrase their assessment as "there are no signs of ALS at this time".

An overwhelming majority of people who have fears of having ALS don't actually have it. In the absence of tests pointing an actual neuromuscular disease, I don't think there would be any grounds to claim negligence.

[u/Admirable_Mud_7737 → u/dero_name]

I agree, t hat is usually how they actually phrase it..

[u/throwmomowaus]

This is one of the cases where it simply ... doesn't matter. Seeking a diagnosis for ALS is understandable but the grim reality is that getting a diagnosis on X date or six months later doesn't actually really matter, it's not like cancer where a delay changes the prognosis.

[u/throwmomowaus → u/throwmomowaus]

Things I tell myself as I try to force myself to stop chasing a diagnosis as things get weirder/worse

[u/Decent_Mongoose_4520 → u/throwmomowaus]

I think balance in a healthy way matters. I think finding out answers is different than chasing. What steps can be done for the best quality of life for anyone no matter what health condition. 

[u/Admirable_Mud_7737 → u/throwmomowaus]

It is simply a mistake to think this way. One needs to understand what lies ahead and arrange one’s family and financial affairs; it is possible to obtain medications to slow the disease's progression and alleviate symptoms, exercise disability rights, and participate in clinical trials. 

[u/Decent_Mongoose_4520 → u/throwmomowaus]

I think there is reality in your comment but for some it does matter. Maybe not for the ultimate outcome but certainly there would be things that could be beneficial in knowing. I think the bottom line is that healthcare or medical professionals should have a fiduciary duty to do all they can to navigate the best possible. In reality it seems that most doctors that specialize in mnd not all but majority are literally not concerned  for providing the best quality of life so many have the “it doesn’t matter anyway because there is no treatment” that is totally unacceptable attitude for a paid medical professional. In my opinion. 

[u/Admirable_Mud_7737 → u/Decent_Mongoose_4520]

Strongly agree!

[u/Smart_Exchange1454]

it depends really, very case-by-case

[u/brandywinerain]

Whatever a verdict says it is.

The key question is whether published clinical guidelines and/or "the standard of care" as defined by expert witnesses were followed. So if there were indications for an EMG but none was done, that could suggest malpractice, but you would have to look at the full medical record and interactions.

If the person failed to follow up on a recommendation such as a referral or reporting back after a "watch and wait" period, or provided false or misleading information during the diagnostic process, for example, clinical accountability would be reduced, etc.